Cancer Curriculum for Appalachian Kentucky Middle and High Schools

Background Appalachian Kentucky faces the highest cancer incidence and mortality rates in the country due to poor health behaviors and lifestyle choices. These poor health behaviors are facilitated by a lack of cancer education. Youth represent a vulnerable population that could be greatly impacted by increased cancer education. Teachers have the power to facilitate this learning. Purpose This study examined the need for cancer education curriculum in Appalachian Kentucky middle and high schools from the perspective of educators. Methods An online survey was conducted with science and health teachers (n=21) in Appalachian Kentucky, consisting of questions that investigated existing cancer education efforts, relevance of cancer education, and feasibility of such curriculum being delivered in the classroom. Content analysis was used to analyze teacher comments. A 3-part cancer education curriculum was developed that is culturally relevant and aligned with science and health education standards. Results All participating teachers agree that cancer education is important to students’ lives. Teachers also agree that there is an inconsistent amount of cancer education within schools, and qualitative content analysis revealed that cancer education likely fits best in certain course subjects. Cancer education could feasibly be integrated into science and health classrooms, although the perception of needing to teach to the academic standards and having limited time to teach additional lessons outside of the standards are significant barriers. To combat this, a cancer curriculum that aligns with state and national science and health education standards was developed. Implications Cancer education curriculum could play an important role in improving the cancer outlook in Appalachian Kentucky. Teachers have expressed a desire for increased cancer education in the classroom. By disseminating and implementing cancer curriculum in schools in the region and revising the curriculum-based on teacher and student feedback to better fit their needs, it has the potential to increase cancer literacy and improve related health behaviors and outcomes.

The first thing you need to do is remind students of what they learned in lesson 1 and 2. Share about what cancer is, its disparities, and its risk factors in the United States. Emphasize Kentucky's high cancer rates and modifiable behaviors in order to create a personal connection and remind them why this topic is so important to Appalachia Kentucky in particular. This can be completed on the title slide of the PowerPoint.

B. Pretest Survey
For this curriculum, students must complete both a pre and posttest questionnaire to gauge their knowledge before and after this lesson. Please have students complete the questionnaire before the lesson and then again after you have delivered the lesson. The questions are listed at the end of this lesson plan under "evaluation." The pre and posttests are identical to one another.

C. Body of the Lesson/Input:
This section will go through the PowerPoint slide by slide to provide additional information and sources for each point.
Slide 2 and 3: These slides encourage students to learn about different cancer treatments in small groups. Assign each group a different type of cancer treatment and ask them to research their treatment in-depth. Things to consider when researching are how the treatment works, why it is useful for patients, and what side effects may occur. Pair them with another group and have each group explain to the other how their treatment works. This will give them a good introduction to two types of cancer treatment. It will deepen their understanding of their assigned cancer treatment by teaching it to another group.
Slide 4: This slide reviews a concept from lesson 1: how cancer is diagnosed. Cancer is diagnosed using a scan followed by a biopsy. A biopsy is a surgical procedure where a doctor removes a small sample of cells in the tumor and sends it to a lab for closer analysis. A researcher will then look at the sample under a microscope to see if it is cancerous. Use the diagram to remind students of the difference between normal and cancerous cells. Treatment can only begin after the cancer has been properly diagnosed.
Reference: https://www.cancer.org/treatment/understanding-your-diagnoses/tests/testingbiopsy-and-cytology-specimens-for-cancer/how-is-cancer-diagnosed.html Slide 5: This slide discusses the concept of early detection. Early detection has been achieved when the cancer is found when it is small and hasn't metastasized yet. When the cancer is this early in its development, there are rarely signs/symptoms that would lead a person to receive an out-of-the-ordinary screening. Typically, early detection is achieved through a regularly scheduled cancer screening, such as a colonoscopy or mammogram. Reference: https://www.cancer.org/healthy/find-cancer-early.html Slide 6: The slide discusses the importance of early detection. A cancer that is small and has not spread is much easier to treat and control than one that is large and has metastasized. Cancers that have metastasized often require intensive treatment and still don't always recede. Early detection greatly improves a patient's chances of surviving. This slide lists the 8 types of cancer treatments that will be discussed in the following slides. There is no need to spend much time on this slide, as each treatment will be covered indepth in the coming slides. Reference: https://www.cancer.org/treatment Slide 10: This slide introduces one of the most common and well-known types of cancer treatment: chemotherapy. When most students think of cancer treatment, they likely think of chemotherapy (chemo). They have likely seen someone they know undergo chemotherapy, resulting in hair loss and fatigue. Chemotherapy uses powerful chemicals to kill cancer cells. The chemicals (either just 1 or a cocktail of different chemicals) are infused through an IV. If multiple chemicals are used, they must be given in a specific order to properly disable the cancer cells. The type and quantity of drugs are decided by the size and stage of the tumor and the patient's age and overall health. If the cancer is smaller and has not metastasized, the chemicals will not be as powerful because they are not necessary to kill the cancer cells. If the patient is older and not healthy, the drugs may not be as powerful for fear of the chemotherapy becoming fatal. Reference: https://www.cancer.org/treatment/treatments-and-side-effects/treatmenttypes/chemotherapy/how-is-chemotherapy-used-to-treat-cancer.html Combination therapy is when a doctor combines two or more drug or treatment types to better fight the cancer. This could mean that surgery is coupled with radiation or that a stem cell transplant is combined with chemotherapy. It could also mean that multiple different drugs are used for targeted therapy. It is extremely common for combination therapy to be incorporated into a cancer treatment plan. Reference: https://pubmed.ncbi.nlm.nih.gov/28410237/ Slide 20: This slide lists the advantages and disadvantages of combination therapy. There are three main advantages. First, combination therapy increases the likelihood that the cancer will be eliminated entirely. If one treatment type does not cause the cancer to recede, another might. Second, combination therapy prevents the development of drug resistance. Some tumors may develop a mutation that allows them to become resistant to the one type of drug. However, it is far less likely that a tumor will develop two random mutations that makes it resistant to two drugs. Lastly, combination therapy reduces the length of treatment. Instead of testing one treatment and waiting to see if the cancer recedes, combination therapy saves the patient precious time by trying different treatments at one time.
There are two main disadvantages. First, there is always a risk when combining different treatment types. It is unclear how the patient's body will react to two competing treatments. There could be severe, adverse side effects. Additionally, it is unclear how two different drugs will interact with one another. To diminish this unknown, extensive research is done on the drugs that are used in combination therapy before they are combined. However, drugs also must go through a clinical trial phase, in which it may be unclear how they will interact with one another. Reference: https://www.sciencedirect.com/topics/medicine-and-dentistry/combination-therapy Slide 21: This slide summarizes what has already been covered in the presentation. There is a lot of material in this lesson! Go over this slide carefully to remind students of what they have learned before transitioning into the discussion period.

D. Discussion Questions:
These questions are designed to help students think more critically about the information presented in the PowerPoint. Time permitting, we recommend having them discuss in pairs or small groups before beginning a large group discussion, but you could also go straight to the large group discussion if necessary. Additional information is provided below each question for you to tell students after the discussion. a. There are a lot of factors to consider when deciding on a treatment regimen. All of the factors mentioned in the previous question are important things to consider. Other important considerations include preexisting health conditions, cost of care, emotional well-being, and whether or not the patient has a strong support system at home. 3.) Is cancer care a single-person job or a team effort? Explain all those involved in cancer treatment both directly and indirectly. a. Cancer care is very much a team effort! Here are just a few of the people that may be involved: doctors, pharmacists, nurses, dieticians, spouses, parents, children, friends, physical therapists, phycologists, social workers, and many, many more. Each one has a specific role. Ask your students to brainstorm how some of these people may be involved!

V. Evaluation
Teacher evaluation Please complete the following evaluation after you have taught the lesson.
• What were the strengths of the lesson?
• What worked well?
• What were problem areas?
• How could you improve the lesson?
• What could you do differently if you were to teach it again?
• What is an alternate way to present the same material?
• Do you have any other comments regarding your experience teaching the lesson? In which scenario would precision medicine not work? a. If the tumor is too large to be targeted by a drug b. If the tumor is too small to be targeted by a drug c. If the tumor has a genetic change that cannot be targeted by a drug d. If the tumor has metastasized already Student Evaluation Answer Key 1) E 2) C 3) D 4) A 5) B 6) D 7) B 8) E 9) D 10) C